This proposal is in response to RFA AR-00-0012, NIAMS Multi- disciplinary Clinical Research Center and is a watershed for the phasing out of the Multipurpose Arthritis Center program and a transition to a Clinical Research Center. Building on a rigorous active preclinical research program and investigator initiated clinical sciences program built over 20 years, we submit 3 proposals whose goals is to improve patient outcomes, a Biometry and Methodology Care to provide consultation and practical support to all projects and Administrative care to enhance interactions and responsiveness to new research opportunities. The research goals of project 1 are to understand the relationships between surgeon-and hospital-volume of total knee arthroplasty and to elucidate the mechanisms by which volume affects outcomes. To know these mechanisms will allow us to improve the effectiveness of this major procedure. It uses powerful statistical tools of claim analysis. Project 2 dissects the effects of functional literacy on outcome and tests a novel intervention to overcome the health disadvantages for subjects with systemic rheumatic diseases who have literacy problems. It breaks new ground in arthritis and musculoskeletal diseases and new methods have been developed to permit its study. It breaks new ground in arthritis and musculoskeletal diseases and new methods have been developed to permit its study. Project 3 attempts to improve SLE patients outcomes and reduce the incidence of accelerated atherosclerosis. That patients with SLE have an exceedingly high risk of accelerated atherosclerosis. That patients with SLE have an exceedingly high risk of accelerated atherosclerosis has been known for over 20 years. It's prevention is unknown the project is a proof of concept study using a cardiac risk profile as a surrogate endpoint.